When coordinating care with a patient who has an advance directive, which approach is best?

• A. Disregard the directive if it conflicts with the current preferences.
• B. Record the directive but ignore it in care planning.
• C. Seek to override the directive if the team disagrees with it.
• D. Respect the patient's documented wishes and discuss them with the care team to ensure care aligns with the directive.

Answer: (D)

Respecting patient autonomy and advance directives guides how care is coordinated. An advance directive is the patient’s documented preferences for medical treatment in situations where they may not be able to speak for themselves, and it has legal and ethical weight. The best approach is to honor those documented wishes and actively discuss them with the care team to ensure every decision aligns with what the patient has chosen. This means confirming the directive’s applicability to the current situation, communicating with the patient or their surrogate to clarify any details if possible, and coordinating with all providers to implement the plan. If any part of the directive is unclear, seek clarification or input from ethics or palliative specialists, but do not act against the documented wishes. Disregarding the directive, recording it but ignoring it in planning, or attempting to override it because the team disagrees undermine patient autonomy and trust, and do not reflect best practice.